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PRECONCEPTION COUNSELING AND CARE FOR HIV-INFECTED WOMEN OF CHILDBEARING AGE PowerPoint Presentation
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PRECONCEPTION COUNSELING AND CARE FOR HIV-INFECTED WOMEN OF CHILDBEARING AGE. Preconception Counseling and Care (1). Preconception care is part of routine primary care and is recommended by the CDC , ACOG, and other national organizations. Purpose: Prevention of unintended pregnancies

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preconception counseling and care 1
Preconception Counseling and Care (1)
  • Preconception care is part of routine primary care and is recommended by the CDC, ACOG, and other national organizations.
  • Purpose:
    • Prevention of unintended pregnancies
    • Optimization of maternal health prior to pregnancy
    • Prevention of perinatal transmission
    • Prevention of HIV transmission to an uninfected partner while trying to conceive

www.aidsetc.org

preconception counseling and care 2
Preconception Counseling and Care (2)

Recommendations

  • Discuss childbearing intentions with all women of childbearing age on an ongoing basis throughout the course of their care. (AIII)
    • Include information about effective and appropriate contraceptive methods. (AI)
  • Preconception counseling: Include information on safer sex and elimination of alcohol, illicit drugs, and smoking. (AII)

www.aidsetc.org

preconception counseling and care 3
Preconception Counseling and Care (3)
  • Include assessment of HIV disease status and need for ART for the health of the woman. (AII)
  • Choose an ART regimen for HIV-infected women of childbearing age based on:
    • Efficacy
    • Hepatitis B status
    • Teratogenic potential
    • Possible adverse outcomes for mother and fetus(AII)

www.aidsetc.org

reproductive options for hiv concordant and serodiscordant couples 1
Reproductive Options for HIV-Concordant and Serodiscordant Couples (1)

All couples:

  • Both partners should be screened for genital tract infections. (AII)
  • Semen analysis is recommended for HIV-infected men. HIV, and possibly ART, may be associated with a higher prevalence of abnormalities.

www.aidsetc.org

reproductive options for hiv concordant and serodiscordant couples 2
Reproductive Options for HIV-Concordant and Serodiscordant Couples (2)

Serodiscordant couples:

  • Expert consultation is recommended. (AIII)
    • No single method of safer conception is fully protective against transmission of HIV.
  • Initiation of ART for the HIV-infected partner is recommended (AI for CD4 counts ≤550 cells/µL and BIII for CD4 counts >550 cells/µL).
    • Maximal viral suppression is recommended before attempting conception. (AIII)
    • HPTN 052 trial showed ART can significantly decrease HIV transmission to uninfected partners.

www.aidsetc.org

reproductive options for hiv concordant and serodiscordant couples 3
Reproductive Options for HIV-Concordant and Serodiscordant Couples (3)
  • HIV-infected female with uninfected male partner: The safest option is artificial insemination, including the option of self-insemination, during the periovulatory period. (AIII)
  • HIV-infected man with uninfected female: Sperm preparation techniques + either intrauterine insemination or in vitro fertilization should be considered if using donor sperm from an uninfected male is unacceptable. (AII)

www.aidsetc.org

reproductive options for hiv concordant and serodiscordant couples 4
Reproductive Options for HIV-Concordant and Serodiscordant Couples (4)
  • Periconception administration of PrEP for HIV-uninfected partners may offer an additional tool to reduce the risk of sexual transmission. (CIII)
    • The utility of PrEP of the uninfected partner when the infected partner is receiving ART has not been studied.
    • Outcome studies are needed to examine adverse events, including risk of congenital abnormalities.

www.aidsetc.org